3367 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SAki,,. ..,.ON PERMIT Perm"ifTVQ � . .C...1 (Complete in Duplicate) , Pate Issued l Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. J08 ADDRESS AND LOCATION ----`'4, ----------- - -••-------•---•------------�-�-L--�'--- -- 16,-5_—Y7 Name----------- ----- -- Phone Address ----------- -----� ---------- - ------ Contractor's Name ----------------------- ----------------------------------•-------- Phone.--------- ------ Installation will serve Residence Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other Number of living units: --�---: Number of bedrooms -------- Number of baths .__l.-_. Lot size --------------.._...1 .. Water Supply: Public system $I Community system ❑_, Private ❑ Depth to Water Table -------- ft. Character of soil to a, depth of 3 feel: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ INo New Construction: Yes E]- No D TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material .--- ----------------- ___......_.__----.- i p Liquid depth � Capacity----------------------- ❑ No: of com compartments -----Size...._--•-__----- li Disposal Field: Distance from nearest well.................Distance from foundation------------------.-Distance to nearest lot line_--.-__------.._. ❑ Number of lines---!-------------------------------Length of each line------------------------------Width of trench.----------------------------_-_-- Type of filter material----------- -------------Depth of filter material-----------------------Total length .._......__-_._....----___-------_______- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 0 ❑ Number of pits- -----------------Lining material------ ----------------Size: Diameter------------... -----Depth--------------------------------- Cessp ol: Distance from nearest we�ll.).._-_------___Distance from f�undation...�_�___----.Linin material... _.-- .'� --- -------D 1S ' Size: f7sameter. eptly Liquid Capacity gals. O 1 a ._. . �.. � a_ u . -- - � . Privy: Distance from nearest well ........... ... ....... Distance from nearesT building....______..._____________-__--____-_-__- }_ ❑ Distance to nearest lot line---------------------------------------------------------------------- ) _ Remodeling and/or repairing (describe):------ -------- ----- j� --•--------------------------------------------------•--------=---------------------•-------------•------------L----•-------�l--a--t---a--.- ' 1 ItI ----------------- -- ---- ------------- ----------------------------------------------=-------------- -------------------------------------••---.----------------•--------------------------------------------------------------------------------------------------- �I - -----------------------------------------------------•---------------------------------------------------------------•------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la wsf.and rules andiregulations of the San Joaquin Local Health District. (Signed).........� _ --r- -- --------- ----(Oand/or Contractor) . , - - --------------- -------------------------------------- ----- -- wner BY:-------------------- -----=--------------- ------------- ---------- --------------------------- (Title) 1 (Plot plan, showing six .of lot, location', of system in rely ion to wells, buildings, etc.,+can be placed on reverse side). t FOR DEPARTMENT USE ONLYy t ; APPLICATION ACCEPTED BY-_ ._-- t DATE---------- REVIEWED BY------ ----------4' J -------- --.- - DATEI 'y:fit, .... .. --------•-------- ------------ ---------- B�JILDING PERMIT fsSUI?... '��- t "_'"~•-�-- DATE '... t Alfierati ns and or re Rommen n :. `"F ` - - -------------- -- - r 1 --- ------ ---- = _� ✓, -------------- ------ --- --c -- - --- --------- - ------- �...�.�.d�r-fir..-�` --- ------ r . ----��------- S y. ._. _ 4_-�._...P---- -- -------=� -- ----------- --�.t •-� '--. ---�"-r-�"L—-----5'�_'_` >• �� " � r - is�__..r�_1•r r''�- 7 yy 1� �y / ` + t .'•S. I4✓'.•�' x^'E'e - VT ._ ------------------------ 4 _ _ 40 4r s ------- ---- r ,�' F A ON BY - ---------------- --------- ate---------- ------------ I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California ! Lodi, California Manteca, California Tracy, California E5-9-21A 10-52 Revised W-2100 f